運動器リハビリテーションを受けた軽度要援護高齢者の自宅退院後の日常生活動作（ADL）変化と関連要因

Factors Related to Changes in Activities of Daily Living among Elderly Patients with Slight Disability who were Discharged to Home

要旨

目的：自宅退院後のADLに関連する要因を明らかにすること．

方法：自宅に退院した運動器関連疾患の高齢者88名を追跡調査し，FIMの変遷に関連する要因を検討した．

結果：受傷前FIMへの到達に関連する要因は，退院後1週目は運動頻度（OR＝1.41），退院後1カ月目は運動頻度（OR＝1.27），退院後3カ月目は退院時の受傷前FIMへの到達（OR＝3.96），自己効力感（OR＝1.16）であった．また，ROC解析の結果，受傷前FIMへの到達に関連する要因は，退院後1週目では運動頻度（カットオフ値＝1.5），1カ月目では運動頻度（カットオフ値＝1.0），3カ月目では自己効力感（カットオフ値＝31.5）であった．退院後早期から週2日以上の運動を継続していた者は，週2日未満の者に比べて，FIM総得点の予後が良好な傾向がみられた．

結論：退院後早期における運動の確保が退院後の予後の改善につながる可能性が示された．

Abstract

Purpose：To clarify factors related to changes in activities of daily living (ADL) among elderly patients who were discharged to home.

Methods：The subjects were 88 persons who received in-hospital musculoskeletal rehabilitation and discharged to home. Factors related to changes in functional independence measure (FIM) score were examined.

Results：The factors related to restoring the FIM score to its values before hospitalization were frequency of physical exercise at 1 week (odds ratio [OR] ＝1.41) and 1 month (OR＝1.27) after hospital discharge, restoring the FIM score at hospital discharge to its value before hospitalization (OR＝3.96), and feeling of self-efficacy (OR＝1.16) at 3 months after hospital discharge. A receiver-operating characteristic analysis revealed that the factors related to restoring the FIM score to its value before hospitalization were frequency of physical exercise (cutoff value＝1.5) at 1 week after discharge, frequency of physical exercise (cutoff value＝1.0) at 1 month after discharge, and feeling of self-efficacy (cutoff value＝31.5) at 3 months after discharge. In addition, ≥ 2 days of physical exercise per week after hospital discharge was more likely to lead to high FIM score than ＜ 2 days of physical exercise per week.

Conclusion：Our results implied that regular physical exercise soon after hospital discharge would lead to better prognosis